Failure to Clarify and Administer Lidocaine Patch for Pain as Ordered
Penalty
Summary
The facility failed to provide pain management in accordance with professional standards, the resident’s person-centered care plan, and the resident’s goals and preferences for one resident. The resident had diagnoses including hypothyroidism and dementia and a care plan identifying risk for altered comfort related to impaired mobility, multiple left rib fractures, polyneuropathy, and pain, with an intervention to medicate for pain as ordered and monitor for effectiveness and side effects. A physiatry progress note documented that the resident’s pain was not well controlled and ordered a routine lidocaine patch to the ribs. Physician orders for a 4% lidocaine external patch directed staff to apply the patch once daily for pain but did not specify the anatomical site of application, despite the intent for rib placement. Review of treatment administration records showed multiple dates on which the lidocaine patch was not administered as ordered. Nursing progress notes repeatedly documented that the patch was not given because the order lacked directions on where to apply it and the resident, due to dementia, was unable to indicate the site. On several other dates when the patch was administered, documentation showed it was applied to various locations including the right hip, right arm, right thigh, left hip, lower back, right deltoid, and once to the lower left abdominal quadrant, with no documentation of application to the ribs. The DON stated she would have expected the order to specify patch placement and for the medication to be administered as ordered.
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